RESUMO
The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease. Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers. For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.
RESUMO
Background: In recent decades, the prevalence of food allergy (FA) in children has increased in Western countries; however, there have been only limited studies on FA, especially among young children, in Asian countries, including Taiwan. In this study, we identified prenatal and perinatal risk factors associated with FA in young children in Taiwan. Methods: For this prospective birth cohort study, we adopted the Southern Taiwan Allergy Research Alliance (STARA)-FA questionnaire to collect data related to prenatal and perinatal risk factors and self-reported allergic symptoms in children aged 1-3 years in the well-baby clinics of 4 medical centers located in 3 cities, Chia-Yi, Tainan, and Kaohsiung, Taiwan. The STARA-FA questionnaire consisted of 99 questions to investigate the association of prenatal and perinatal risk factors with FA. Results: We recruited 903 young children aged 1-3 years in Taiwan. Among those, 95 (14.7%) children had allergic reactions to foods. The most common food allergens were eggs (26/95, 27.3%), milk (22/95, 23.2%), fruits (13/95, 13.7%), and seafood (12/95, 12.6%). We also found that there were 134 (14.8%) children with eczema, 86 (9.5%) with wheezing, and 240 (26.6%) with rhinitis. Children with a personal history of eczema (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.38-4.45) and a family allergy history (AOR, 2.06; 95% CI, 1.18-3.57) had a significantly increased risk of FA. Maternal peanut consumption during pregnancy was associated with a decreased risk of FA in children (AOR, 0.57; 95% CI, 0.33-0.98). Conclusions: In this study, the prevalence of FA in a cohort of Taiwanese young children was 14.7%. Risk factors associated with FA were a personal eczema history and a family allergy history, which might serve as predictive or prevention factors for the development of FA in young children in Taiwan.
RESUMO
Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.